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THE  FEEDING  OF 
INFANTS 

HOME  GUIDE  FOR  MODIFYING 
MILK 


BY 

Joseph  E.  Winters,  M.D. 

PROFESSOR  OF    DISEASES  OF   CHILDREN,    CORNELL 
UNIVERSITY   MEDICAL   COLLEGE 

a  5  /  2.  X 


NEW  YORK 
E.  P.  DUTTON  &■  COMPANY 

31    WEST  TWENTY-TH!RD   STREET 
1901 


Copyright,  1901 

BY 

E.  P.  DUTTON  &  CO. 


TEbe  ftniclierbocftec  pceM,  Aew  fiorfe 


CGpA 


TO 

ALL  LITTLE  CHILDREN 

WHOSE  WELFARE  IS 

CLOSEST  TO  MY  HEART 

I  DEDICATE  THE  FOLLOWING  PAGES 


INTRODUCTION 

The  fundamental  guides  in  the 
feeding  of  infants  are  the  com- 
position of  human  milk,  the 
amount  of  milk  secreted  by  the 
breasts  of  a  healthy  nursing  wo- 
man, and  the  capacity  of  the 
stomach  of  the  infant. 

The  correct  composition  of 
human  milk  was  discovered  by 
Dr.  Arthur  V.  Meigs,  of  Phila- 
delphia, in  1882.  His  father, 
the  late  Dr.  J.  Forsyth  Meigs, 
by  repeated  and  untiring  invest- 
igations, determined  accurately 
the  amount  of  milk  secreted  by 
the  breasts  of  a  healthy  nursing 
woman. 


vi  Introduction 

In  1872,  Frolowsky,  of  Russia, 
published  measurements  made 
after  death  of  the  capacity  of 
the  stomach  of  infants  at  differ- 
ent ages. 

It  is  now  nineteen  years  since 
the  last  of  these  investigations 
was  published.  Notwithstanding 
this  fact,  there  has  been  no  dis- 
semination of  the  central,  cardi- 
nal principles  on  which  the 
proper  feeding  of  infants  is 
founded.  These  three  essentials 
are  fully  considered  in  the  text  of 
this  work,  and  they  should  be  fa- 
miliar to  every  mother  and  nurse. 

On  pages  13  to  17  I  have 
arranged  charts,  based  on  long 
experience  and  repeated  analyses 
of  milk  and  cream,  that  will  en- 
able any  one  to  prepare  food  of 


Introduction  vii 

definite  percentages  for  infants 
of  different  ages — from  birth  to 
the  end  of  the  first  year. 
Joseph   E.  Winters,  M.D. 

New  York,  25  West  37th  St. 
January,  igoi. 


Feeding  of  Infants 

Home  Guide  for  Modifying 
Milk 


2.  6"y  2  -2. 

Two  facts  should  be  ever  pres- 
ent in  the  mind  when  considering 
the  feeding  of  infants. 

First :  Of  children  born  heal- 
thy, and  exclusively  breast-fed, 
very  few  die  during  the  first  year 
of  life,  even  in  institutions,  or 
among  the  poor  in  tenements  ;  a 
breast-fed  infant  is  seldom  ill, 
rarely  coming  under  a  physician's 
care  until  after  the  period  of 
weaning. 

Second  :  Of  children  artificial- 
ly fed,  in  institutions  and  in  tene- 


2  Feeding  of  Infants 

ments,  very  few  survive  the  first 
year. 

In  these  two  immutable  facts 
we  have  consummate  proof  that 
mother's  milk  is  the  ideal  food 
for  infants. 

When  this  is  impracticable,  the 
only  method  by  which  we  can 
establish  the  value  of  an  artificial 
substitute,  is  to  compare  it  with 
wor^an's  milk. 

A  substitute  for  human  milk 
must  resemble  that  perfect  model 
as  closely  as  possible,  in  chemical 
composition  and  physiological 
properties. 

This  is  an  infallible  law  in 
artificial  feeding.  It  is  empha- 
sized by  the  following  records. 
In  Germany  the  Government 
requires  that  the  death  certifi- 
cate of  an  infant  under  one  year 
of  age  shall  state  what  the  mode 
of    feeding    has    been.      These 


Modifying  Milk  3 

records  show  that  8  per  cent,  of 
children,  exclusively  nourished 
by  mothers,  die  during  the  first 
year  of  life.  Of  children  fed  on 
artificial  foods,  51  per  cent,  die 
during  the  first  year. 

The  mortality  in  the  Berlin 
Charity  Hospital  ranges  from 
59  to  93  per  cent. 

In  the  Buda-Pesth  Foundling 
Hospital,  during  twelve  years, 
the  mortality  has  never  exceeded 
15  per  cent. 

In  the  former  institution  the 
children  are  artificially  fed,  in 
the  latter,  with  few  exceptions, 
the  mother  nurses  her  child. 

It  is  my  purpose  to  show  that 
this  enormous  difference  in  mor- 
tality between  natural  and  arti- 
ficial feeding  is  preventable. 

Among  the  intelligent  upper 
classes,  where  artificial  feeding 
is  now  carried  out  on  scientific 


4  Feeding  of  Infants 

lines,  the  artificially  fed  infant 
usually  thrives. 

In  institutions  and  in  tene- 
ments, it  is  an  ever-changing, 
fortuitous  system  that  is  prac- 
tised. It  is  not  infrequent  to 
find  that  a  dozen  foods  have 
been  tried  in  as  many  weeks, 
and  all  with  equally  disastrous 
results. 

An  artificial  food  for  an  infant 
must  fulfil  the  following  require- 
ments. 

First :  It  must  contain  all  the 
constituents  which  are  found  in 
human  milk. 

Second  :  These  constituents 
must  be  present  in  the  same 
proportions  as  in  human  milk. 

Third  :  It  must  contain  noth- 
ing that  is  not  found  in  human, 
milk. 

Fourth  :  It  must  be  of  animal 
origin. 


Modifying  Milk  5 

Fifth  :  It  must  be  fresh. 

Infraction  of  these  laws  is 
the  cause  of  the  excessive  mor- 
tality from  artificial  feeding. 
The  last  three  are  frequently 
disregarded,  but  never  with  im- 
punity. 

The  only  universally  available 
food  that  can  be  made  to  meet 
these  five  essential  conditions  is 
cow's  milk. 

Until  within  a  comparatively 
recent  period,  however,  cow's 
milk  has  often  proved  disastrous 
as  a  food  for  infants.  The  cause 
of  this  and  its  elucidation  were 
discovered  by  Dr.  Arthur  V. 
Meigs,  of  Philadelphia,  in  1882, 
when  he  made  known  to  the 
medical  profession  for  the  first 
time  the  accurate  percentages 
of  the  various  constituents  con- 
tained in  human  milk.  He 
discovered     that     human     milk 


6  Feeding  of  Infants 

contains  i  per  cent,  of  caseine, 
or  proteid.^ 

Previous  analyses  had  made 
the  percentages  of  this  constitu- 
ent too  high.  (This  is  the  con- 
stituent of  milk  which  produces 
the  curd  when  coagulation  takes 
place.)  It  is  the  large  propor- 
tion of  caseine,  or  curd,  in  cow's 
milk,  that  makes  it,  when  un- 
diluted, so  difficult  for  infants 
to  digest. 

Cow's  milk  contains  4  per 
cent,  of  proteid. 

Human  milk  contains  i  per 
cent,  of  proteid. 

RELATIVE    PROPORTIONS    OF    THE 

CHIEF     CONSTITUENTS     CON- 

TAINED    IN    HUMAN    AND 

COW'S  MILK. 

Human  Milk. 

Fat 4. 00^ 

Milk-sugar 7.CX)  >•  approximate. 

Proteids i .  00  J 

'  Caseine,  albuminoid,   and  proteid  are  syn- 
onymous. 


Modifying  Milk  7 

Cow's  Milk. 

Fat 4.ooi 

Milk-sugar 4  •  50  >-  approximate. 

Proteids 4.00  ) 

Consequently,  to  make  cow's 
milk  a  suitable  food  for  infants, 
it  must  be  so  diluted  as  to  contain 
I  per  cent,  of  proteid. 

Cow's  milk  so  diluted  becomes 
deficient  in  fat  and  milk-sugar; 
these  have  to  be  supplied. 

The  following  exemplifies  this 
statement : 

Cow's  Milk  Diluted. 

Milk  I  part,  water  3  parts. 

Fat 1. 00  ) 

Milk-sugar 1.12  >  approximate. 

Proteids i.oo) 

In  human  milk,  fat  and  milk- 
sugar  are  greatly  in  excess  of  the 
proteids ;  in  cow's  milk,  these 
three  constituents  are  in  nearly 
equal  proportions. 

Cream,  like  human  milk,  con- 
tains a  high  percentage  of   fat, 


8  Feeding  of  Infants 

with  a  low  percentage  of  proteids. 
With  cream,  or  super-fatted  milk, 
milk-sugar  and  boiling  water,  we 
can  with  facility  prepare  a  food  of 
any  given  percentages  that  the  in- 
fant's age  or  digestive  power  may 
call  for.  For  early  infancy,  when 
a  low  percentage  of  proteids  is  re- 
quired, it  is  necessary  to  have 
cream  with  a  very  high  percent- 
age of  fat. 

We  often  find  that  for  the  first 
few  days  of  life,  the  proteids 
must  be  reduced  to  one  half  of  i 
peT  cent,  or  even  one  quarter  of 
I  per  cent,  until  the  child's 
stomach  becomes  accustomed  to 
the  digestion  of  this  constituent 

Many  of  the  failures  in  home- 
modification  are  undoubtedly  the 
result  of  not  giving  explicit  di- 
rections as  to  the  length  of  time 
after  milking  when  the  cream 
should  be  removed  from  the  milk, 


Modifying  Milk  9 

and  as  to  the  quantity  that 
should  be  taken  from  each  quart 
bottle. 

For  infant  feeding  it  makes  a 
decided  difference  as  to  the 
amount  of  top  milk  that  is  taken 
from  each  quart  of  milk. 

In  order  to  determine  accur- 
ately the  percentages  of  fat  and 
proteids  in  different  cream  layers 
in  a  quart  bottle  of  milk,  I  had 
numerous  analyses  made  by  Prof. 
Adriance.  I  have  had  these  an- 
alyses repeated  by  Dr.  Lederle, 
of  the  New  York  Health  Board, 
and  by  Mr.  Henry  C.  Sherman, 
at  Columbia  University. 

These  analyses  were  made  with 
a  view  of  determining  the  value 
of  a  conviction,  based  upon  clin- 
ical experiences  in  the  feeding  of 
infants,  that  the  upper  cream  lay- 
ers contain  a  comparatively  low 
percentage  of  proteids,  with  the 


lO         Feeding  of  Infants 

result  that  such  conviction  was 
confirmed  in  every  instance  by 
the  analyses. 

In  metropolitan  centres,  all 
milk  reaches  the  consumer,  prac- 
tically speaking,  sixteen  or  more 
hours  after  the  time  of  milking. 

The  upper  ounce  from  a  quart 
of  such  milk  shows  the  following 
composition  : 

Fat 23.80  per  cent. 

Milk-sugar 3.90    "      " 

Proteids 2.90    "      " 

The  upper  four  ounces  from  a 
quart  of  milk  sixteen  or  more 
hours  after  milking  show  the  fol- 
lowing composition  : 

Fat 21.80  per  cent. 

Milk-sugar 4.00    "      " 

Proteids 3.00    "      " 

The  Upper  eight  ounces  from 
a  quart  of  milk  sixteen  or  more 


Modifying  Milk  1 1 

hours  after  milking  show  the  fol- 
lowing composition  : 

Fat 17.00  per  cent. 

Milk-sugar 430    "      " 

Proteids 3.10    "      " 

With  the  above  instructions 
and  analyses,  it  is  easy  to  prepare 
a  food  of  any  desired  percentages. 

During  the  early  days  of  in- 
fancy no  more  than  0.25  per 
cent,  of  proteids  should  be  given, 
and  no  less  than  2  per  cent,  of 
fat.  With  these  low  percentages 
it  is  practicable  to  feed  an  infant 
the  first  day  of  its  life  artificially, 
without  any  disturbance  of  diges- 
tion. I  state  this  positively, 
from  a  large  experience  in  labor- 
atory feeding,  where  the  percent- 
ages are  accurate. 

Infants  so  fed  do  not  lose 
weight  the  first  week  of  life,  as 
they  formerly  did,  when  two  or 


12         Feeding  of  Infants 

three  days  were  allowed  to  elapse, 
before  the  use  of  food  or  of 
breast  milk  was  begun. 

The  following  tables  give 
explicit  directions  for  the  prep- 
aration of  food  for  infants  of  dif- 
ferent ages.^ 

During  the  summer  months  the 
strengthening  of  the  food  should 
be  more  gradual  than  has  been 
indicated  in  these  formulae. 

An  infant  of  three  or  four 
months  will  not,  as  a  rule,  digest 
more  than  i  per  cent,  of  pro- 
teids  in  hot  weather. 

Many  of  the  digestive  derange- 
ments incident  to  this  period 
may  be  averted  by  increasing  the 
proportion  of  lime  water  to  one 
fourth  of  the  total  quantity  dur- 
ing the  heated  term. 

'  Human  milk  is  alkaline,  cow's  milk  is  acid  ; 
this  necessitates  the  addition  of  an  alkali  to  the 
mixture  ;  lime  water  is  used  for  this  purpose. 


Modifying  Milk  13 


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Feeding  of  Infants 


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1 8        Feeding  of  Infants 

The  above  formulae  are  com- 
puted for  milk  of  good  quality, 
which  has  been  bottled  for  i6 
hours  or  longer.  Nearly  all  of  the 
fat  will  then  have  risen  into  the 
upper  8  or  9  ounces.  Hence 
the  amount  of  fat  contained  in 
the  mixtures  made  by  the  above 
formulae  will  be  proportional  to 
that  of  the  original  milk,  and  will 
vary  with  the  richness  of  the 
latter. 

With  milk  from  the  same 
source,  however,  the  composition 
would  probably  be  as  constant  as 
that  of  mother's  milk,  and  the 
gradation  of  composition  from 
that  of  human  milk  to  that  of  the 
cow's  milk  used  in  making  the 
mixtures  would  be  easy  and  reg- 
ular. Children  get  over  slight 
chemical  differences  in  cow's  milk 
much  more  readily  than  they  do 
physical    differences — those  due 


Modifying  Milk  19 

to  contamination.  This  is  abun- 
dantly proven  by  analyses  of 
woman's  milk  where  chemically 
it  was  far  from  correct,  yet  the 
nurslings  were  thriving. 

After  preparing  the  food,  it 
should  be  put  in  as  many  bottles 
as  there  are  feedings  for  the  24 
hours,  each  bottle  containing  the 
amount  for  one  feeding  ;  the  bot- 
tles are  then  stoppled  with  steri- 
lized cotton,  placed  in  the  nursery 
refrigerator  until  wanted,  and 
kept  at  a  temperature  of  45°  to 
50°  F. 

There  are  two  unmistakable 
and  unerring  guides  regarding 
the  quantity  of  food  for  each 
feeding,  namely,  the  capacity  of 
the  stomach  of  infants,  and  the 
amount  of  milk  secreted  by  the 
breasts  of  a  healthy  nursing  wo- 
man. The  former  was  ascer- 
tained with    great    accuracy    by 


20        Feeding  of  Infants 

Frolowsky,  of  Russia,  the  latter 
by  Prof.  J.  Forsyth  Meigs,  of 
Philadelphia,  and  Prof.  J.  Lewis 
Smith,  of  New  York.  The  re- 
sults of  the  investigations  of 
these  three  men  have  been  taken 
as  the  standard  guides  of  writers. 

CAPACITY  OF  STOMACH  IN  INFANTS. 

(Frolowsky)  : 

Age  Capacity  Age  Capacity 

Week.  in  ounces.  Week.  in  ounces. 

1st                      I  1 2th  3  J 

4th                     24  1 6th  al 

8th                   Si  2oth  3i 

OVER-FEEDING. 

Over-feeding  is  one  of  the 
greatest  banes  of  bottle-fed 
children,  and  causes  more 
indigestion  and  ill  health  than 
is  generally  believed,  even  by 
physicians. 

After  the  first  few  weeks  of 
life  the  stomach  should  rest  for 
several  hours  at  niorht.      With  a 


Modifying  Milk  21 


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22         Feeding  of  Infants 

little  care  and  patience,  the  child 
can  be  taught  the  habit  of  being 
fed  at  definite  periods,  and  will 
waken  for  its  meals  with  wonted 
regularity. 

A  weekly  gain  in  weight  is  the 
best  indication  that  the  infant  is 
being  properly  nourished.  Dur- 
ing the  first  half  year,  the  nor- 
mal weekly  gain  is  about  four 
ounces ;  during  the  next  six 
months,  a  little  less.  A  prop- 
erly fed  child  is  satisfied  after 
taking  its  bottle,  and  will  fall 
asleep  until  the  next  feeding. 
Over-feeding  is  indicated  by  a 
restless,  wakeful  state,  caused  by 
indigestion.  The  mother  or 
nurse  frequently  ascribes  these 
symptoms  to  hunger,  and  the 
child  is  fed  whenever  it  cries,  the 
disturbed  digestion  being  aggra- 
vated thereby. 

The  danger  of  giving  too  little 


Modifying  Milk  23 

food  is  infinitesimal,  as  com- 
pared to  the  danger  of  giving 
too  much. 

Some  infants  have  individual 
peculiarities  concerning  their 
food.  Such  cases  require  the  at- 
tention of  the  family  physician. 
No  deviation  from  the  rules  for 
feeding"  should  ever  be  made 
without  consulting  a  physician. 

TO    HEAT    THE    FOOD. 

Place  the  bottle  in  a  vessel  pro- 
vided for  the  purpose  (see  list, 
pages  26  to  30),  containing  tepid 
water ;  heat  it  gradually  by 
means  of  an  alcohol  flame,  or  a 
Bunsen  gas-burner,  until  the  milk 
is  from  99°  F.  to  102°  F.,  as 
tested  by  a  dairy  thermometer. 

The  milk  is  kept  warm  during 
the  feeding,  by  placing  the  bot- 
tle in  a  flannel  case,  closed  at  the 
top  with  a  draw-string. 


24        Feeding  of  Infants 

POSITION    DURING    FEEDING. 

The  infant  should  He  on  the 
arm  of  the  attendant,  in  the  posi- 
tion it  would  be  in  taking  the 
breast.  This  semi-erect  position 
diminishes  the  risk  of  strangula- 
tion, and  the  milk  is  less  likely  to 
be  regurgitated  ;  the  stomach  of 
the  infant  being  almost  vertical, 
and  having  no  muscular  ring  to 
protect  it  at  the  upper  end,  where 
the  esophagus,  or  gullet,  opens 
into  it. 

TIME    ALLOWED    FOR    FEEDING. 

The  nursing  infant  is  about 
fifteen  to  twenty  minutes  in  tak- 
ing its  meal ;  the  bottle-fed  child 
should  take  about  the  same 
time.  Rapid  feeding  is  a  com- 
mon cause  of  indio-estion  in 
hand-feeding. 

After  feeding,  the  child  should 


Modifying  Milk  25 

be  put  in  its  crib  and  kept  quiet. 
It  must  not  be  carried  about, 
swung  in  the  air,  jolted  in  the 
lap,  or  slmken  in  its  carriage. 
Many  cases  of  serious  vomit- 
ing in  infants  have  had  as  their 
sole  cause  these  inane,  jig-jog, 
dandling  movements. 

BOTTLES. 

The  bottles  should  be  grad- 
uated, of  transparent  flint  glass, 
cylindrical  in  shape,  with  a  wide 
neck.  They  should  be  of  two 
sizes,  of  four  and  eight  ounces. 
There  should  be  as  many  in  use 
as  there  are  feedings  in  the 
twenty-four  hours. 

After  each  feeding,  the  bottle 
should  be  thoroughly  rinsed  with 
cold  water,  then  filled  with  cold 
water  and  bicarbonate  of  soda 
(teaspoonful  to  pint).  Immedi- 
ately before  putting  milk  in  them, 


26         Feeding  of  Infants 

they  should  be  placed  in  a  vessel 
and  boiled  in  filtered  water  for 
ten  minutes. 

NIPPLES. 

Black  rubber  conical  nipples, 
with  a  single  small  hole,  are  the 
best. 

Immediately  after  using,  they 
should  be  washed  with  warm 
water  and  borax  (teaspoonful  to 
pint),  turned  inside  out  and  thor- 
oughly cleansed,  then  placed  in 
a  glass  bowl  (kept  exclusively 
for  the  purpose),  and  filled  with 
sterilized  water  ;  this  is  to  be  fre- 
quently renewed. 

Immediately  before  using, 
they  should  be  put  in  boiling 
water  for  a  moment. 

EQUIPMENT. 

In  order  to  secure  satisfactory 
results  in  home  modification  of 


Modifying  Milk  27 

milk,  too  great  stress  cannot  be 
laid  upon  the  selection  of  appro- 
priate articles  with  which  to  work. 
These  should  be,  as  far  as  possi- 
ble, of  glass,  aluminum,  or  of  such 
ware  as  is  of  a  smooth  surface. 

A  table  used  solely  for  this 
purpose  should  be  kept  in  a 
light  and  airy  room. 

A  glass  case  for  the  smaller 
articles  is  commended,  while  a 
glass  top  to  the  table  is  a  further 
security  against  germs. 

Each  article  should  be  abso- 
lutely essential  and  practical. 

A  large  tray  should  be  set 
upon  the  table,  and  the  follow- 
ing things  should  be  on  it,  or  at 
hand  in  the  case,  ready  for  im- 
mefdiate  use  : 

A  small  dipper  holding  ^ 
ounce,  to  take  out,  without  dis- 
placing it,  the  top  cream  from  a 
quart  bottle  of  milk. 


28        Feeding  of  Infants 

A  double  boiler,  one  section  to 
be  used  for  mixing  the  feedings, 
while  the  second  section  may  be 
used  for  heating  water  (later 
this  utensil  may  be  used  for  pre- 
paring the  child's  cereals). 

Three  jars,  to  contain  respect- 
ively milk-sugar,  borax,  bicar- 
bonate of  soda.  Each  jar  to  be 
distinctly  marked. 

Two  quart  bottles,  to  contain 
lime  water  and  alcohol.  The  bot- 
tles to  be  plainly  lettered. 

A  spirit  lamp  (a  French  model 
is  the  safest). 

A  Bunsen  gas-burner. 

A  tablespoon. 

A  teaspoon. 

A  funnel  (with  large  mouth  to 
insure  cleanliness).  • 

I  dozen  4-ounce  flint  glass 
graduated  bottles. 

J  dozen  8-ounce  flint  glass 
graduated  bottles. 


Modifying  Milk  29 

A  box  of  sterilized  cotton. 

A  stand  to  hold  ten  bottles. 

An  8-ounce  measuring  glass. 

A  flat-bottomed  narrow  ves- 
sel, to  contain  water,  in  which 
to  place  a  bottle  while  heating 
milk. 

A  dairy  thermometer. 

A  box  of  black  rubber 
"  Home"  nipples. 

A  small  glass  bowl,  in  which 
to  keep  two  nipples  in  use. 

Flannel  cases,  in  which  to 
place  bottle,  to  keep  milk  warm 
while  infant  is  feeding. 

A  glass  jug,  to  contain  filtered 
sterilized  water. 

A  basin  in  which  to  "wash 
up. 

A  set  of  wash  cloths. 

A  set  of  dish  towels. 

A  small  pail  for  waste  water. 

A  nursery  refrigerator. 

A  table  with  complete  equip- 


30        Feeding  of  Infants 

ment  for  infant  feeding,  known 
as  "  The  Noel  Nursery  Table," 
has  recently  come  to  my  notice, 
and  is  a  valuable  adjunct  to  the 
nursery  for  artificial  feeding. 

MILK    SUPPLY. 

Uncontaminated  milk  is  neces- 
sary for  successful  infant  feeding. 
Contaminated  milk,  however 
carefully  modified  or  pasteurized, 
will  cause  disordered  digestion 
in  the  young  child.  It  is  perti- 
nent, therefore,  briefly  to  con- 
sider the  conditions  which  are 
essential  for  the  supply  of  pure 
milk. 

Mixed  milk  from  a  herd  is 
preferable  to  the  milk  from  one 
cow,  as  it  is  more  uniform  in 
composition. 

The  herd  must  be  regularly 
subjected  to  the  tuberculin  test, 
to  exclude  tubercular  cattle. 


Modifying  Milk  31 

The  cows  must  be  groomed 
before  milking,  and  the  udders 
and  teats  washed  and  dried. 

The  milkman's  hands  must  be 
sterilized  before  milking.  He 
must  wear  clean,  washable  clothes 
while  milking ;  wash  his  hands 
before  milking  each  cow,  and 
keep  them  dry  while  milking. 

The  cows  must  be  milked  in  a 
building  provided  for  the  pur- 
pose, apart  from  the  stables. 

The  milking  must  be  done 
into  sterilized  quart  glass  bot- 
tles ;  the  milk  should  at  once  be 
cooled  to  a  temperature  of  40° 
F.  ;  the  bottles  immediately 
sealed  and  labelled  across  the  cap, 
with  the  name  of  the  dairyman 
and  the  date  of  the  milking. 
This  provision  facilitates  in- 
vestigation, should  the  milk  be 
suspected  as  the  source  of  conta- 
gious disease. 


32         Feeding  of  Infants 

Any  person  living  in  a  house 
where  there  is  contagious  dis- 
ease, or  who  may  in  any  wise  be 
exposed,  directly  or  indirectly,  to 
contagion,  must  not  have  any- 
thing to  do  with  the  dairy,  or  the 
handling  of  the  milk. 

In  the  event  of  contagious 
disease  appearing  on  the  farm, 
the  patrons  must  be  notified  at 
once,  and  the  milk  supply  dis- 
continued, although  still  paid  for. 

This  precaution  obviates  temp- 
tation to  conceal  the  existence 
of  contagion. 

PASTEURIZATION. 

It  is  a  popular  belief  that  pas- 
teurization makes  cow's  milk, 
even  if  fresh  aftd  pure,  a  more 
suitable  food  for  infants.  This 
is  erroneous  :  Fresh,  pure  milk 
is  not  improved  by  pasteuriza- 
tion ;  it  is  not  more  digestible, 


Modifying  Milk  33 

and  it  is  in  no  way  a  better  food 
for  an  infant. 

Does  pasteurization  deterior- 
ate fresh  milk  ?  I  have  seen 
scurvy  where  pasteurized,  modi- 
fied milk  had  been  the  only  food. 
Recovery  was  rapid  with  the  con- 
tinued use  of  the  same  food,  raw. 

A  physician  told  me  in  the 
autumn  of  1898  that  he  had 
three  cases  of  scurvy  during  that 
summer  in  his  practice — one  his 
own  child.  All  three  children 
had  been  fed  on  modified  milk, 
pasteurized. 

What  is  the  aim  of  pasteuriza- 
tion ? 

First  :  To  destroy  disease 
germs  in  milk. 

Second  :  To  enhance  its  pre- 
servation— to  prevent  its  turning 
sour. 

Where  the  practicable  rules 
for  providing  a  pure  milk  supply 


34         Feeding  of  Infants 

are  effective,  pasteurization  for 
the  destruction  of  disease  germs 
is  unnecessary. 

Preservation  of  milk.  Experi- 
ments at  the  Yale  University 
Agricultural  Experiment  Station 
have  fully  proved  that  when  milk 
is  cooled  immediately  after  milk- 
ing to  a  temperature  of  40°  P., 
all  bacteria  growth  is  at  once 
arrested,  and  continues  so,  if  the 
milk  is  kept  at  a  low  temperature. 
Under  such  conditions  milk  will 
keep  sweet  three  weeks.  This 
has  been  done  in  this  country  and 
also  in  England. 

By  medical  supervision  of  the 
milk  production,  it  is  practicable 
to  remove  wholly  the  danger 
(never  a  frequent  one)  of  con- 
tagious disease  germs ;  and  by 
scrupulous  cleanliness  in  hand- 
ling the  milk,  and  keeping  it  at 
a  temperature   of   40°    P.,  milk 


Modifying  Milk  35 

may  be  secured,  having  all  the 
advantages  claimed  for  pasteur- 
ized milk,  without  any  of  its  dis- 
advantages. 

At  the  meetingr  of  the  Ameri- 
can  Pediatric  Society,  June,  1899, 
Prof.  Forcheimer  stated  :  "  Our 
ideal  food  in  the  future  is  going 
to  be  raw  milk." 

Prof.  T.  M.  Rotch  says  :  "  The 
endeavor  should  always  be  made 
to  prevent  impurities  from  get- 
ting into  the  milk,  in  preference 
to  trying  to  eradicate  them  after 
they  have  begun  to  alter  its 
normal  composition." 

Pasteurization  will  not  make 
contaminated  milk  pure,  nor 
stale  milk,  fresh.  Such  milk 
should  never  be  given  to  infants  ; 
— it  ought   to  be  thrown  away. 

Supervision  is  more  of  a  safe- 
guard than  dependence  upon 
pasteurization. 


36         Feeding  of  Infants 

Conclusions.  First :  Where 
the  production  and  handling  of 
milk  are  properly  guarded,  pas- 
teurization is  unnecessary. 

Second  :  Experience  with  pas- 
teurization demonstrates  that 
when  cow's  milk  is  used  as  a  sub- 
stitute for  human  milk,  absolute 
freshness  is  a  factor  of  prime 
importance. 

Third :  Fresh,  raw  milk  is 
superior  in  nutritive  value  to 
that  which  has  been  artificially 
changed  by  pasteurization. 

RECAPITULATION. 

We  have  seen,  then,  that  for 
the  successful  substitution  of 
cow's  milk  for  human  milk,  the 
following  conditions  are  essen- 
tial: 

First :     Pure,  fresh  milk. 

Second  :  It  must  be  so  modi- 
fied that  the  proportions  of  the 


Modifying  Milk  37 

different  constituents  are  made 
the  same  as  in  human  milk. 

Third :  Scrupulous  cleanliness. 

Fourth  :  Quantity  at  each  feed- 
ing, as  indicated  by  the  tables. 

Fifth :  Semi-erect  position 
during  feeding.  / 

Sixth  :     Feeding  slowly. 

Seventh  :  Regularity,  as  given 
in  schedule. 

Eighth  :  Temperature  of  food 
99°  to  102°  F. 

Ninth :  After  the  first  few 
weeks,  six  or  eight  hours  of  rest 
at  night  for  the  digestive  organs. 

PREDIGESTED    FOODS. 

Continued  use  of  predigested 
foods  weakens  the  stomach  of  an 
adult  by  relieving  it  of  work  it 
should  do. 

Prolonged  use  of  these  foods 
for  healthy  infants  so  enfeebles 


/ 


38        Feeding  of  Infants 

digestion  that  it  takes  years  to 
restore  it,  if  at  all. 

It  should  be  borne  in  mind 
that  the  digestive  powers  of  the 
infant  need  to  be  developed,  and 
consequently  the  use  of  pepto- 
genic  milk-powder,  or  other  pep- 
sine  preparations,  can  not  be  used 
continuously  in  healthy  infants 
with  impunity, 

INFANT    FOODS. 

Something  must  be  said  about 
the  so-called  "  Infant  Foods" 
which  are  being  so  constantly 
pressed  before  the  attention  of 
mothers  by  most  enticing  adver- 
tisements. 

There  is  but  one  standard  by 
which  to  judge  these  ubiquitous 
commercial  foods,  viz.,  human 
milk.  The  proportions,  and  the 
nature  of  the  constituents  con- 


Modifying  Milk  39 

tained  in  it,  are  the  criterion  of 
what  an  infant's  food  should  be 
when  artificially  made. 

Tested  by  this  unerring  stand- 
ard, not  one  of  these  foods  fulfils 
one  of  the  conditions  required  of 
a  substitute  for  human  milk. 

Prof.  Chittenden,  of  Yale  Uni- 
versity, Prof.  Leeds,  of  Stevens 
Institute,'  and  other  chemists, 
have  by  repeated  analyses  de- 
monstrated that  every  infant  food 
on  the  market  is  deficient  in  fat, 
milk-sugar,  and  albuminoid. 

The  large  amount  of  fat  in 
human  milk  is  conclusive  as  to 
its  great  importance. 

Fat  serves  most  important  pur- 
poses in  the  nutrition  of  growing 
infants, — enters  largely  into  the 
structure  of  brain,  nerve,  and 
the  marrow  of  bone,  and  serves 
as  fuel,  producing  heat  and 
force ;  every  commercial  food  is 


40         Feeding  of  Infants 

strangely  destitute  of  this  vital 
constituent. 

What  is  of  more  weighty  con- 
sequence than  the  relative  pro- 
portions of  the  various  constitu- 
ents contained  in  these  foods,  is 
their  nature, —  the  source  from 
which  they  are  derived. 

Milk  is  purely  an  animal  food, 
of  animal  origin  ;  these  foods,  on 
the  contrary,  are  vegetable,  of 
vegetable  origin. 

A  food  may  have  high  nutri- 
tive value  at  one  period  of  life, 
at  another  be  useless,  or  even 
injurious,  owing  to  inability  of 
the  individual  to  digest  it.  Na- 
ture has  not  endowed  infants 
with  digestive  power  to  deal  with 
vegetable  products.  With  pro- 
found disregard  of  this  physio- 
logical fact,  the  proprietary  foods 
are  almost  entirely  vegetable. 

Albuminoid    is    the    form    of 


Modifying  Milk  41 

material  in  which  nitrogen  is  sup- 
plied to  the  body.  Nitrogen 
enters  into  the  structure  of  every 
cell.  The  blood  and  all  the  tis- 
sues of  the  body  are  formed  by 
cells.  Nitrogenous  matter  is  es- 
sential to  every  vital  process, 
consequently  the  growing  child 
requires  more  albuminoid  in  pro- 
portion to  its  weight  than  the 
adult.  These  foods  contain  as  a 
substitute  for  the  albuminoid  of 
milk,  nitrogenous  material  de- 
rived from  barley  or  other  grain. 
Vegetable  albuminoid  and  animal 
albuminoid  are  not  identical. 

Vegetable  albuminoid  must 
underofo  transformation  into  ani- 
mal  albuminoid  before  it  can  be 
utilized  for  the  purpose  of  cell 
growth, —  for  the  structure  of 
brain,  nerve,  muscle.  Vegetable 
albuminoid  is  more  difficult  of 
digestion  and   assimilation  than 


42         Feeding  of  Infants 

animal  albuminoid  ;  despite  this 
fact,  manufacturers  offer  it  to  the 
delicate,  hitherto  untried  diges- 
tive organs  of  the  infant. 

A  child  exclusively  fed  on  any 
one  of  these  foods  has  but  one 
chance  in  fifty  with  a  milk-fed 
child  in  a  battle  with  acute  dis- 
ease. 

These  foods  are  all  deficient  in 
milk-sugar. 

Human  milk  contains  7  per 
cent,  of  this  constituent  from  the 
beginning  to  the  end  of  the  nurs- 
ing period.  Milk-sugar  is  readily 
assimilable,  and  undergoes  direct 
transmutation  into  animal  heat. 
The  imperfectly  developed  nerv- 
ous system  of  the  infant  produces 
little  heat.  Nature  has  made 
provision  for  the  undeveloped 
heat  centre  in  the  infant  by  the 
large  amount  of  animal  sugar 
supplied    to    it    in    its    dietetic 


Modifying  Milk  43 

birthright.  Manufacturers  have 
substituted  for  this  animal  con- 
stituent, starch,  dextrose  or  mal- 
tose. The  vegetable  substitutes 
are  difficult  of  digestion  and  as- 
similation, and  in  many  instances 
produce  digestive  or  other  dis- 
turbances, instead  of  supplying 
animal  heat. 

The  proportion  of  fat,  sugar, 
and  albuminoid  contained  in 
these  foods  is  wholly  immaterial. 
The  nature  of  these  constituents 
and  the  entire  absence  of  animal 
element  disqualify  them  abso- 
lutely as  substitutes  for  human 
milk. 

Milk  is  formed  from  the  blood  ; 
its  composition  is  closely  allied 
to  blood.  The  water  passes  from 
the  minute  blood-vessels  into  the 
milk  ducts,  carrying  with  it  the 
mineral  constituents  in  solution, 
and  part  of  the  albumin  of  blood. 


44         Feeding  of  Infants 

The  larger  part  of  the  albumin 
is  changed  during  its  passage, 
and  appears  as  caseine,  the  al- 
buminoid of  milk. 

For  this  secretion  from  the 
blood — this  "  blanched  blood  " — 
it  is  endeavored  to  substitute  a 
vegetable  product. 

Milk  is  a  living  fluid,  and  dif- 
fers from  all  mixtures  advertised 
as  substitutes  in  tha;t  the  process 
of  manufacture,  by  which  they 
have  been  rendered  capable  of 
being  preserved,  has  converted 
them  into  dead  material. 

Neither  chemistry,  nor  com- 
merce, will  ever  be  able  to  place 
on  the  market  a  product  which 
will  fulfil  the  conditions  required 
of  a  substitute  for  this  living  fluid, 
freshly  secreted  from  the  blood. 

Fresh  food  is  required  at  every 
period  of  life. 

We  all  know  that  scurvy  is  a 


Modifying  Milk  45 

sequence  of  a  diet  of  salt  or 
canned  provisions.  Infants  also 
are  liable  to  scurvy  from  th^pro- 
tracted  use  of  preserved  foods, 
such  as  condensed  milk,  dried 
milk  preparations,  or  any  of  the 
so-called  "  Infant  Foods."  I  have 
seen  over  sixty  cases  of  scurvy, 
every  one  of  them  being  due  to 
the  prolonged  use  of  commercial 
foods,  or  of  over-heated  milk — 
which  is  a  preserved  food. 

Most  of  these  cases  were  in 
the  country,  where  fresh  milk 
was  almost  at  the  door. 

One  extreme  case  was  that  of 
a  child  sixteen  months  old,  whose 
father  had  eight  hundred  acres  of 
fertile  land  and  a  large  dairy  ;  the 
baby  had  never  tasted  milk  !  Re- 
covery was  complete  on  Walker- 
Gordon  "  Modified  Milk  "—not 
pasteurized — without  other  treat- 
ment. 


46         Feeding  of  Infants 

The  hospitals  and  dispensaries 
in  this  country,  and  in  Europe, 
furnish  irrefutable  evidence  that 
the  enormous  difference  in  mor- 
tality between  naturally  and  arti- 
ficially fed  children  is  due  to  the 
extensive  use  of  these  foods. 

With  our  present  enlighten- 
ment, it  seems  inexplicable  that 
in  the  past  many  physicians  of 
high  attainments  recommended 
commercial  foods.  The  explan- 
ation is,  that  not  knowing  the 
composition  of  human  milk,  they 
could  not  know  how  to  modify 
cow's  milk  as  a  substitute  for  it. 
The  discovery  of  the  accurate 
composition  of  woman's  milk 
contains  the  seminal  principle  of 
the  modification  of  cow's  milk. 
From  one  to  the  other  is  a  natural 
step  in  infant  feeding.  Modi- 
fied milk  is  the  inevitable  con- 
sequent   of     Meigs'     discovery. 


Modifying  Milk  47 

His  enlightenment  will  eventu- 
ally eliminate  preserved  foods 
forever  from  the  nursery. 

This  discovery,  with  its  hap- 
piest results  and  full  fruition,  will 
cause  the  total  disappearance  of 
rickets  and  scurvy  in  infants ;  a 
diminution  of  the  gastro-intesti- 
nal  diseases  ;  a  lowered  mortality 
from  all  the  acute  diseases  ;  a 
higher  degree  of  health,  and 
therefore  of  happiness  and  use- 
fulness, of  every  artificially  fed 
child. 

Meigs'  discovery,  when  fully 
appreciated  by  physicians  and 
mothers,  will  be  the  means  of 
saving  more  lives  than  any 
other  discovery  made  by  medi- 
cal science  during-  the  nineteenth 
century,  as  it  will  affect  more  or 
less  the  life  and  health  of  every 
child  born  into  the  world. 


3  1158  00107  4821 


UC  SOUTHERN  I^aONAL  L'BWW  [S, 


A    001368  380    o 


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